Better screening could save 350 lives a year

Liver Health Around 350 people die in the UK each year as a result of our haphazard approach to screening for primary liver cancer. It's time for a better system.

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Around 3,000 people are diagnosed with primary liver cancer each year in the UK, and the survival rate is poor. Yet this is a preventable cancer.

It is usually a result of lifestyle-related long-term liver damage, typically caused by alcohol, hepatitis C, or obesity-related fatty liver disease.

"If people at risk can be treated before cirrhosis sets in, liver cancer can be prevented," says Dr Stephen Ryder, hepatologist at Nottingham NHS Treatment Centre.

However, surveillance is patchy. Currently aimed mainly at those with cirrhosis, liver cancer screening involves blood and ultrasound tests. "Whether people are offered screening varies widely throughout the UK. A centrally or regionally organised system of regular screening and recall for people at risk could save 350 lives a year," says Dr Ryder.

At present it is sometimes done irregularly and people are not always offered the blood test for the alpha-feto protein that can signal cancer.

There is a variety of treatment options. The introduction five years ago of sorafenib, which kills cancer cells by blocking the signals that make them grow and divide, was hailed as a step forward. It improves average survival rates by 12 weeks but its expense means that it is unavailable on the NHS, though funding may be available through the Cancer Drugs Fund.

The NHS does around 700 liver transplants every year, many for primary liver cancer. Surgery to remove cancerous areas of the liver plays a minor role in treatment because although the liver can regenerate after much is removed, cirrhosis impairs this ability.

Other treatments include chemoembolisation which delivers drugs directly to the tumour, often in combination with a gel or tiny plastic beads which block the blood flow to the tumour to help destroy it. In some cases the beads contain the anti cancer drug themselves.

Tumour ablation involves heating the cancer cells with microwaves or radio waves to destroy them. It works well on small isolated tumours but not those that are larger or scattered.

Then there is SIRT - selective internal radiotherapy treatment - in which beads filled with a radioactive substance deliver radiotherapy to tumours and cut off their blood supply simultaneously.

A new trial combining chemoembolisation and sorafenib is recruiting now but results will not be available for about a year.